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SA N J OAQ U I N Environmental Health Deparcmeni <br /> C0UI'aTY-- <br /> TEMPORARY FOOD VENDOR'S APPLICATION <br /> Ali food vendors (both for profit and non-profit)are required to return a signed and completed copy of this checklist to <br /> the festival coordinator thLZAI <br /> 3)week rior to this event, <br /> t �` <br /> 1. 1.Name of Event �i fryte CS event, <br /> �7�%� Date(s): <br /> 2. The following is information about my organ izationfbus iness: <br /> Name of organization/business: l e f i <br /> Address: 91 C) ��►� �1 z <br /> Phone: ( Zoq ) tr�W Z C I _ Alternate <br /> 3, List food to be so!d or given to the pLrblic: Cct 1 eel "Cs_ C 0 F;" )IrI/l�j <br /> 4. 1 am providing food that is NOT prepared at home: ❑Yes YNo <br /> All food is prepared on-site or is from approved commercial facilities: ❑Yes❑No <br /> Name of facility: Phone: ( 1 <br /> Address of facility: <br /> 5, l an,providing a bee#€ eolith the fo!lovrin;_!ta protect my unpackaned food and food-preparation areas from flies, <br /> dust and the public) <br /> ❑A booth with walls and ceiling constructed of either wood, canvas, plastic, similar material and fine mesh fly <br /> screening, completely enclosing open food areas. It will also have a smooth and cleanable floor (concrete, <br /> asphalt, clean tarps and smooth wood are acceptable) and constructed to separate food and food preparation <br /> areas from the public. <br /> Other(specify): ( <br /> Note: The only operations not required to provide enclosed booths are those which sell beverages from <br /> approved dispensers, or prepackaged foods from approved sources. <br /> 6. Approved water for drinking, utensil and hand washing grill be provided in my booth by the followng methods: <br /> ❑Approved bottled water. <br /> ❑On-site hose bib that is connected to a potable water s}ource_ <br /> Other(specify): 1 �[ I it <br /> 7. lectricity is provided far my booth's use: XYes❑ No <br /> 8. 1 am providing an accurate probe the cme-r to measure the hot and cold holding of potentially hazardous <br /> foods during all times of booth operatioAe,.ntroi <br /> Yes❑No <br /> 9. 1 am providing the following hot tempera' for the hot holding of aii potentiaily iazardeus foods above <br /> 135°F: <br /> ❑Camp stove ❑Sterna&hotel trays <br /> ❑ Double steamer ❑Steam table&lids <br /> ❑ Electric stave top ❑Other(specify) <br /> Note: Examples of potentially hazardous food include: meats, tamales, cooked beans, rice, <br /> vegetables,potato salad,eggs,and dairy products. <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br /> EHD 15-02 Pagc 7 cf ti THMP EVENTApP <br /> 0713117 <br />